Exercise and Osteoarthritis

Position Statement

The Faculty of Sport and Exercise Medicine (FSEM) UK recognises the importance of movement and exercise when it comes to managing Osteoarthritis. Evidence overall suggests that exercise is good for healthy joints. Osteoarthritis is a chronic disease affecting 8.75 million people in the UK[i], and more research is needed to fully understand the effects of exercise on Osteoarthritis.

The FSEM (UK) has produced the following Exercise and Osteoarthritis ten point guide, including key points on exercise prescription for health professionals:

Exercise does not cause Osteoarthritis

1. Evidence overall suggests that exercise is good for joints and does not cause Osteoarthritis. Exercise can help prevent and treat Osteoarthritis, however, there is a need for further, large scale, collaborative research to fully describe the effects of exercise on Osteoarthritis (timing, type and threshold).

2. Joint and musculoskeletal health can be optimised by maintaining aerobic fitness, enhancing muscle strength and avoiding weight gain – together these factors, which are modifiable, can help reduce joint loading and prevent Osteoarthritis.

3. The strongest risk factors for Osteoarthritis are obesity, family history, female sex and injury with interplay between genes and environment. Avoidance of repetitive overload or significant acute injury i.e. directional change, collision is important. Individuals should try not to be over-weight and be aware of their family history. Recreational running does not cause Osteoarthritis, it does not wear out joints – Osteoarthritis is not a ‘wear and tear’ disease.

Exercise reduces joint pain and improves function

4. Individuals should minimize risks by not repeating the same multidirectional sports activity on successive days and consider non-impact loading exercise where appropriate i.e. cycling, cross-trainer, and swimming. Individuals should choose a form of exercise they like or suits them – preferably something that can be integrated into their daily life.

5. Exercise prescription[ii] for minimizing the risk of Osteoarthritis should include individuals following the UK Physical Activity Guidelines for aerobic and strength training. A combination of strength, flexibility and aerobic work is most beneficial with aquatic and land-based exercise equally as effective. The individual should include higher intensity activity if they can and meet UK Physical Activity Guidelines to reduce co-morbidities.

6. Exercise reduces joint pain and improves function. It can also improve self-efficacy and self- management. Exercise can help manage weight loss and other chronic co-morbidities: 90% 65yrs + with Osteoarthritis have at least one other chronic condition.

In Knee Osteoarthritis exercise decreases pain in up to 75% of patients

7. In knee Osteoarthritis, exercise decreases pain and improves function in 50-75% of patients. There is no significant difference between strength and aerobic exercise, and low and high intensity exercise. Exercise may initially cause increased joint pain – after 6-8 weeks pain relief typically occurs. Whilst the evidence-base for hip and hand Osteoarthritis is less strong the same advice should be given.

8. There is significant evidence for exercise intervention in Osteoarthritis improving pain and function, with moderate to large effect sizes. Not all patients with Osteoarthritis have visible radiological      changes – start exercise advice early for those with joint pain.

9. Arthritis Research UK has produced useful exercise sheets and videos for individuals with Osteoarthritis.

10. The Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis www.sportsarthritisresearchuk.org is a multidisciplinary international research collaboration working to understand the relationship between exercise and Osteoarthritis, and to determine who does well or poorly following injury.

Conclusion

Exercise is central to the self-management of Osteoarthritis and all patients should be offered information and education. There is strong evidence to suggest being more active and less sedentary is beneficial for overall and musculoskeletal health.

Author: Professor Mark E Batt,  email:mark.batt@nottingham.ac.uk

References:

Fransen M and McConnell S Cochrane review 2009

Vincent KR PM R 2012 Resistance exercise for knee OA

Bicshoff and Roos Curr Opin Rheum 2003

Brosseau L Cochrane Database Syst Rev 2003

©Faculty of Sport and Exercise Medicine UK. Published August 2014, reviewed March 2018, next review March 2021.

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Position statements published by the FSEM (UK) are quick reference or information documents for the Sport and Exercise Medicine and healthcare community. They can include up to ten short points of clinical relevance and are designed to be useful short reference documents.

The FSEM (UK) will publish updates to its official position statements as and when new information is available. The current versions will appear on the website, including the date published, and will supersede and replace prior versions. FSEM UK does not circulate or endorse out of date versions of its position statements.

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[i] Arthritis Research UK

[ii] Individuals should discuss the most suitable ways to exercise with their doctor or healthcare provider to maximise health benefits